ABSTRACT: Asthma is the leading chronic pediatric disease in the US, making it a serious and costly public health issue. Children are hospitalized due to asthma for a variety of reasons such as environmental factors and patterns in healthcare. Asthma hospitalizations also exhibit large disparities across many socio-environmental factors. Much can still be learned and there has been little research contrasting disparities across different contextual factors, especially rural/urban. Furthermore, geographical factors are well-known determinants of health disparities and thus a clearer picture of the role that ?place? has in the asthma burden could better elucidate risk factors and their synergistic effects, which can lead to improved interventions to address disparities. Spatial epidemiology provides a unique pathway to support this mission as improved assessment of risk factors over space and time can improve public health strategies for addressing disparities in this complex disease. The overarching goal of this research is to improve understanding of neighborhood and environmental risk factors driving disparities in pediatric asthma ED visits. The primary hypothesis for this proposal is that disparities in such risk factors will associate with asthma-related health disparities in children and that these associations will be modified by characteristics of place. To address this, we will employ innovative Bayesian statistical methodologies to analyze highly resolved spatio-temporal data comprised of health outcomes, demographic information, and environmental measures from South Carolina. Our first aim is to identify the spatio-temporal health disparity patterns in pediatric asthma. Our second aim is to quantify the long-term drivers of asthma disparities. Finally, the third aim is to quantify the short term drivers of asthma disparities in an acute health effects framework. The immediate impacts of this work will identify, disaggregate, and rank the factors that contribute to asthma ED visit disparities across many socio- environmental factors, notably urban/rural disparities. This project will refine estimates of environmental exposures and known risk factors of pediatric asthma ED visits, and their interactive effects. The long-term impacts will advance the epidemiologic analysis of disparities in pediatric asthma, a complex and multifactorial disease that has proven challenging to study with existing methods. The research will inform future case- control and cohort research designs of the importance for both collecting and analyzing highly precise spatio- temporal data to better detail health disparities. Furthermore, this research will generate tangible location- specific evidence to direct interventions to reduce disparities in ED visits and their heavy human and financial costs, which could then be used to assess the effectiveness of forthcoming telehealth interventions in improving health trajectories and outcomes among vulnerable children.